From the Guidelines
The prognosis for someone with Crohn's disease who has had three bowel resections and is not on treatment is generally poor, with a high risk of disease recurrence, additional bowel resections, complications, and reduced quality of life. Without appropriate medical management, they face specific risks including intestinal strictures, fistulas, abscesses, malnutrition, and short bowel syndrome (which can lead to malabsorption and dependence on parenteral nutrition) 1. The risk of colorectal cancer also increases with longstanding inflammation. Each subsequent bowel resection removes more intestinal tissue, potentially leading to intestinal failure.
Key Considerations
- The inflammatory nature of Crohn's disease means that without treatment to control the underlying immune dysregulation, inflammation will likely continue to damage the digestive tract, leading to progressive deterioration of bowel function and overall health.
- Immediate treatment with medications such as biologics (adalimumab, infliximab, ustekinumab), immunomodulators (azathioprine, 6-mercaptopurine), or combination therapy is strongly recommended to prevent disease progression, as suggested by the American Gastroenterological Association institute guideline on the management of Crohn's disease after surgical resection 1.
- Regular monitoring through colonoscopies, imaging, and laboratory tests is essential, along with nutritional support and smoking cessation if applicable.
Treatment Recommendations
- Anti-TNF therapy and/or thiopurines are recommended over other agents for patients with surgically induced remission of CD, due to their effectiveness in reducing disease recurrence, with anti-TNF therapy resulting in 49% and 76% relative reductions in clinical and endoscopic recurrence at 18 months, respectively, and thiopurines resulting in 65% and 60% relative decreases in clinical and endoscopic recurrence, respectively 1.
- Postoperative endoscopic monitoring at 6 to 12 months after surgical resection is suggested for patients receiving pharmacological prophylaxis, and recommended for those not receiving pharmacological prophylaxis 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Future Prognosis of Crohn's Disease
The future prognosis of someone with Crohn's disease not on treatment who has had three bowel resections in the past is uncertain. However, some studies provide insight into the efficacy of treatments for Crohn's disease:
- Aminosalicylates, such as sulfasalazine and mesalamine, have been shown to have modest efficacy in inducing remission in patients with mildly to moderately active Crohn's disease 2, 3.
- Sulfasalazine was found to be more likely to induce remission compared to placebo, but was less effective than corticosteroids 2, 3.
- Mesalamine was not found to be superior to placebo for induction of remission, except for high-dose mesalamine (≥ 2.4g) which was more effective than placebo, but ranked lower than systemic corticosteroid and high-dose budesonide 3, 4.
- The use of 5-aminosalicylates for maintaining medically induced remission is not supported by the evidence 4.
Treatment Options
Treatment options for Crohn's disease include:
- Aminosalicylates, such as sulfasalazine and mesalamine, which may be considered for inducing remission in selected patients with mild luminal CD who prefer to avoid steroids 4.
- Corticosteroids, which are more effective than aminosalicylates in inducing remission, but may have more adverse effects 2, 3.
- Other treatments, such as biologics and JAK inhibitors, which may be considered for patients with more severe disease or who have not responded to other treatments.
Bowel Resections
The impact of three bowel resections on the prognosis of Crohn's disease is not directly addressed in the provided studies. However, it is known that repeated bowel resections can lead to complications such as short bowel syndrome and malabsorption 5, 6.